Incontinence: Shocking Numbers of Fit, Young Women Have This Problem

The first time Amanda Cooke peed her pants she was a junior in high school. She was running on a trail during cross-country practice when she felt a warm stream rush down her legs. "All of a sudden, I just peed, and I was like, 'What do I do?'" remembers Cooke, now a 36-year-old in Columbus, Ohio.

Immediately worrisome was the fact that she and her teammates had to take a bus back to school from the trail, then she had to ride in a car with a friend from school to her home. "I had to sit on the bus being all stinky," she says, "and I was like, 'Please don't let anybody notice.'"

Today, Cooke still experiences urinary incontinence while running, but she stopped caring long ago if anyone notices. She's been through five childbirths and a 100-pound weight loss, and is now an elite-level marathoner who simply warns those around her that she "smells like a homeless man" after races. She wears a pad in her underwear and shorts that won't chafe her legs when wet.

"It is what it is," she says. "I've lost all shame of anything."

While incontinence is often viewed as something women may only have to deal with after having children or in old age, it's also remarkably common among young, athletic women and girls who've never had kids. In fact, research suggests more than one-quarter of collegiate female athletes who've never had children experience urinary incontinence while participating in their sport. (Gymnasts and basketball players suffered most frequently – 67 percent and 66 percent, respectively – while swimmers, volleyball players, softball players and golfers were least affected.)

Another study found that 35 percent of female Olympic track and field athletes leaked while competing in the games. And a recent study including 372 elite female Portugese athletes (the vast majority of whom weren't mothers) found that nearly 30 percent had urinary incontinence, while only 13.4 percent of non-elite controls reported the same.

"It's rampant. This is a well-understood issue and it's been going on for a long time," says Julie Wiebe, a physical therapist in Los Angeles who specializes in pelvic health issues in fitness. "It's not just a postpartum issue."

But treating it as a postpartum issue – as many clinicians do – only exacerbates the problem among athletes – be they pro, amateur or just serious gym rats, experts say. That's because while urinary incontinence among new moms is typically due to a weakened pelvic floor that can be strengthened through exercises like kegels (or practicing the sort of gripping action that stops urine mid-flow), the same problem in young fitness fanatics seems to be due in part to an exercise routine that emphasizes rock-hard abs but neglects neighboring internal muscle groups. For them, kegels can be the worst thing to do since it puts more pressure on an already disproportionately strained system, says Isa Herrera, a physical therapist and strength and conditioning coach in New York City who founded

"I'm not talking about your occasional runner – I'm talking about people who are doing a lot of core and butt work and strengthening and running and cycling and P90X, and when I test them vaginally, what I find is they're too tight," she says. "They're doing kegels, and they don't have a normal range of motion, and they're creating more dysfunction and they leak more."

Fortunately, there are solutions for this population. If you're in it, start with these four steps:

1. Speak up.

If you haven't told your doctor, coach or another professional about leaking during exercise because you've brushed it off as normal or no big deal, think again."[Women] think it's normal – especially postpartum. That's what their doctor will tell them," Wiebe says. "Everyone in their running club leaks; everyone in their CrossFit box leaks. It's very common, but it's not normal."

More than not normal, it's not healthy. "It's not just that they're wetting their pants," Wiebe adds. "It's part of a system; it's a signal the system isn't working well, and they will not perform as well and it will eventually lead to injuries." For example, you could suffer strains, falls or imbalance issues if your incontinence is linked to poor extension of your leg while running.

2. Know that you don't have to stop exercising.

Not long ago, the prevailing advice for any woman struggling with pelvic floor problems was to stop exercising. That advice doesn't fly for committed athletes. "I would tell people, 'please stop,' and they would tie up their tennis shoes and literally run from the clinic home," says Wiebe, who calls herself "an aging female athlete." "I need to create solutions for them."

Today, solutions exist that don't disrupt your training. Herrera, for example, often teaches women exercises that help stabilize their pelvises. She may also introduce a vaginal weight, which they can use while running or doing yoga to improve their sense of where various muscle groups are. "It's not acceptable for an athlete to be leaking while doing their program," she says. "They're going to be repercussions as they get pregnant or as they age. A sensible program will go a long way."

3. Find the right professional.

If you're treated by a pelvic floor specialist who usually works with postpartum women or a sports medicine physician who usually works with athletes recovering from knee injuries, chances are, you won't get a helpful prescription. Same goes for docs who just aren't up on the minimal research in this niche area.

"Generationally, we're seeing an increase in activity levels for women," Wiebe says. "We're pushing the boundaries of what our bodies can do, and I think that's awesome, and in doing that we're discovering there are some extra vulnerabilities we might need to find solutions for."

If you are experiencing incontinence problems the therapists at Starting Line Physical Therapy are available for consultations on what can be done to treat the issue. 

4. Lean and breathe.

For runners experiencing incontinence, Wiebe has two general pieces of advice: lean and breathe. That means leaning forward while running in a way that improves range of motion in the legs and relaxes the abdomen. As a result, you'll reduce some of the upward pressure on the pelvic floor that contributes to the problem. At the same time, she coaches women to inhale while expanding their bellies rather than sucking them in. That reduces some of the downward pressure that adds to incontinence.

With practice, both techniques can help treat incontinence – and even improve athletes' performance. "Lean and breath," Weibe says. "If you can do just that, you're going to change your circumstances." 

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